Provider Demographics
NPI:1740322585
Name:FISHER, FLORRIE (MSS)
Entity type:Individual
Prefix:MS
First Name:FLORRIE
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:MSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LAKESIDE OFFICE PARK
Mailing Address - Street 2:504 LAKESIDE DRIVE
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-4078
Mailing Address - Country:US
Mailing Address - Phone:215-354-0777
Mailing Address - Fax:215-354-0772
Practice Address - Street 1:LAKESIDE OFFICE PARK
Practice Address - Street 2:504 LAKESIDE DRIVE
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-4078
Practice Address - Country:US
Practice Address - Phone:215-354-0777
Practice Address - Fax:215-354-0772
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW003151L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAFF633910Medicare ID - Type UnspecifiedCLINICAL SOCIAL WORKER